Analysis of the use of imipenem at a University Hospital following the restructuring of an antimicrobial audit system

This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS® for Windows® PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0 percent) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0 percent) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients.

Analysis of the use of imipenem at a university hospital following the restructuring of an antimicrobial audit system.

This study analyzed the use pattern of imipenem following the restructuring of the antimicrobial audit system at a University Hospital. It was an observational study before and after the restructuring of the antimicrobial audit system in a University Hospital from May to August and then from September to December 2006. The criteria of the rational use of imipenem were obtained from a non-systematic revision of the literature. The collection of data on the general characteristics and clinical state of the patient, the infection and the established therapy was carried out in a previously tested instrument. Data was recorded, revised and analyzed in a database built with the software SPSS for Windows PC, version 10.0. The statistical analysis had a descriptive character: frequencies, mean, median and standard deviation. No differences were encountered in relation to the appropriate indication, consumption and clinical outcomes of patients. However, there was a reduction of 4 to 1 (75.0%) in the number of associations with spectrum superposition and an increase of 4 to 8 (50.0%) in the change of therapy. The restructuring of the antimicrobial audit system in the studied hospital did not reflect significantly the increase of the appropriate indication of imipenem. It contributed, however, to the reduction of the inappropriate associations of this antibiotic and to changes of therapy, without, however, compromising the quality of services rendered to patients.

[Drug-related clinical research--a practical opportunity for the hospital pharmacist]. / La investigación clínica con medicamentos: una oportunidad práctica para el farmacéutico hospitalario.

OBJECTIVE: To describe a pharmacist s field of activity in drug-related clinical trials. METHOD: A non-systematic assessment of available scientific literature in international databases queried during the period of May 05 to 31, 2005. RESULTS: In all, 36 papers were obtained regarding the role of hospital pharmacists in the development of drug-related clinical trials. Most common activities included dispensation, storage, and inventory. Participation in ethics committees and study coordination represent an expanding area. CONCLUSIONS: Drug-related clinical research is an excellent practical setting for the hospital pharmacist. Activities related to investigational drug control, including dispensation, randomization scheme management, and patient follow-up, are an example. This is a novel though rapidly expanding scenario in Brazil.

Validation of criteria for nosocomial use of amikacin in Brazil with the Delphi technique

The Delphi technique has been used since the 1950s to collect the opinions of experts; to gauge their indications, and in some instances, to develop a consensus. This systematic collection and aggregation of informed judgments from a group of experts on specific questions or issues is a highly efficient and cost-effective means to establish guidelines and policies, when compared to other strategies, such as committee meetings or personal interviews. OBJECTIVE: Examine the content validation process of the proposed criteria of the American Society of Health System Pharmacists (ASHP) for amikacin use in hospital settings. MATERIAL AND METHODS: The Delphi technique was applied using the proposed ASHP criteria questionnaire containing 102 specific questions related to the nosocomial use of amikacin by individual patients. The questionnaire contained six groups of questions: 1) Identification and basic demographic data, 2) Relevant data for the use of amikacin, 3) Justification of its usage, 4) Critical parameters of amikacin use, 5) Complications, 6) Measurement of results. Eight hospital specialist medical doctors were selected, including five in the area of infectious diseases, one surgeon, one nephrologist and one in critical care medicine. The questionnaire was e-mailed to the doctors and they were asked for their opinion about the appropriateness of the questions. They were to say whether the general concept seemed totally or partially adequate to the proposed process, what grade (0 to 10) they would give to each section, and if there were any perceived deficiencies, they could add, omit or modify individual questions. A second questionnaire containing the questions for which there had been no consensus based on the answers to the previous one was re-sent to the participants for consolidation. RESULTS: Feedback revealed an agreement of 75 percent concerning the utility and appropriateness of sections 1 and 2. The section about the justification of amikacin usage was agreed on by 50 percent. There was a total agreement of 62 percent for the critical parameters of amikacin use, and a partial agreement of 37 percent. The complication of usage of the questionnaire was agreed upon by 50 percent of the participants, and positive measurement of the results was totally agreed on by 62 percent, and partially by 37 percent. The overall score for the questionnaire was 8.77 ± 0.25. CONCLUSION: The usage criteria for amikacin recommended by ASHP were validated by the Delphi technique for utilization in Brazilian hospital settings. The Delphi technique applied to validate a questionnaire instrument for monitoring the correct use of a specific strategic antibiotic indicated for the treatment and prophylaxis of serious antibiotic-resistant Gram-negative bacteria, proved to be a reliable and simple tool for designing guidelines and a consensus document for hospital use of antibiotics.

La investigación clínica con medicamentos: una oportunidad práctica para el farmacéutico hospitalario / Drug-related clinical research--a practical opportunity for the hospital pharmacist

Objetivo: Describir el campo de acción del farmacéutico en ensayos clínicos con medicamentos. Método: Evaluación no sistemática de la literatura científica disponible a través de bases de datos internacionales consultadas en el periodo del 5 a 31 de mayo de 2005. Resultados: Se rescataron 36 artículos relacionados con la participación del farmacéutico hospitalario en el desarrollo de ensayos clínicos con medicamentos. Las actividades más comunmente desarrolladas fueron la dispensación, almacenamiento e inventario. La participación en comités de ética y actividades de coordinación de estudios representa una práctica en expansión. Conclusiones: La investigación clínica con medicamentos constituye un excelente campo de práctica para el farmacéutico de hospital. Las actividades de control de los medicamentos bajo investigación tales como la dispensación, gestión de los esquemas de aleatorización y el seguimiento de los pacientes son ejemplo de esta actuación. En Brasil este escenario es nuevo pero en franco crecimiento

Objective: To describe a pharmacist's field of activity in drug related clinical trials. Method: A non-systematic assessment of available scientific literature in international databases queried during the period of May 05 to 31, 2005. Results: In all, 36 papers were obtained regarding the role of hospital pharmacists in the development of drug-related clinical trials. Most common activities included dispensation, storage, and inventory. Participation in ethics committees and study coordination represent an expanding area. Conclusions: Drug-related clinical research is an excellent practical setting for the hospital pharmacist. Activities related to investigational drug control, including dispensation, randomization scheme management, and patient follow-up, are an example.This is a novel though rapidly expanding scenario in Brazil

Validation of criteria for nosocomial use of amikacin in Brazil with the Delphi technique.

UNLABELLED: The Delphi technique has been used since the 1950s to collect the opinions of experts; to gauge their indications, and in some instances, to develop a consensus. This systematic collection and aggregation of informed judgments from a group of experts on specific questions or issues is a highly efficient and cost-effective means to establish guidelines and policies, when compared to other strategies, such as committee meetings or personal interviews. OBJECTIVE: Examine the content validation process of the proposed criteria of the American Society of Health System Pharmacists (ASHP) for amikacin use in hospital settings. MATERIAL AND METHODS: The Delphi technique was applied using the proposed ASHP criteria questionnaire containing 102 specific questions related to the nosocomial use of amikacin by individual patients. The questionnaire contained six groups of questions: 1) Identification and basic demographic data, 2) Relevant data for the use of amikacin, 3) Justification of its usage, 4) Critical parameters of amikacin use, 5) Complications, 6) Measurement of results. Eight hospital specialist medical doctors were selected, including five in the area of infectious diseases, one surgeon, one nephrologist and one in critical care medicine. The questionnaire was e-mailed to the doctors and they were asked for their opinion about the appropriateness of the questions. They were to say whether the general concept seemed totally or partially adequate to the proposed process, what grade (0 to 10) they would give to each section, and if there were any perceived deficiencies, they could add, omit or modify individual questions. A second questionnaire containing the questions for which there had been no consensus based on the answers to the previous one was re-sent to the participants for consolidation. RESULTS: Feedback revealed an agreement of 75% concerning the utility and appropriateness of sections 1 and 2. The section about the justification of amikacin usage was agreed on by 50%. There was a total agreement of 62% for the critical parameters of amikacin use, and a partial agreement of 37%. The complication of usage of the questionnaire was agreed upon by 50% of the participants, and positive measurement of the results was totally agreed on by 62%, and partially by 37%. The overall score for the questionnaire was 8.77 +/- 0.25. CONCLUSION: The usage criteria for amikacin recommended by ASHP were validated by the Delphi technique for utilization in Brazilian hospital settings. The Delphi technique applied to validate a questionnaire instrument for monitoring the correct use of a specific strategic antibiotic indicated for the treatment and prophylaxis of serious antibiotic-resistant Gram-negative bacteria, proved to be a reliable and simple tool for designing guidelines and a consensus document for hospital use of antibiotics.

[Outlining passive information offered by the Drug Information Center of the Federal University of Bahia College of Pharmacy]. / Perfil de las informaciones pasivas del Centro de Información de Medicamentos de la Facultad de Farmacia de la Universidad Federal de Bahía.

OBJECTIVE: To outline passive information offered by the Drug Information Center (DIC) of the Federal University of Bahia College of Pharmacy. METHODOLOGY: Descriptive and prospective study of requests received at the DIC from March, 1997 to December, 2003. Results, represented as frequencies, were obtained by using Microsoft Excel. RESULTS: 1,267 requests were received in the study period. Thirty seven percent (37%) of these involved patients; 73% were done by telephone and 66% were answered the same way; 68% of the requests were made by pharmacists. About 39% of all requests were originated in hospitals and 23% in community pharmacies. A total of 1,459 questions were received, showing a proportion of 1.2 questions per information request, of which: 18% were related to drug indication/use; 13% to adverse reactions; 17% to identification of national and foreign products and active substances; 8% to posology and 6% to drug interactions. Fifty nine percent of the requests were answered within 23 hours.

Perfil de las informaciones pasivas del Centro de Información de Medicamentos de la Facultad de Farmacia de la Universidad Federal de Bahía / Outlining passive information offered by the Drug Information Center of the Federal University of Bahía College of Pharmacy

Objetivo: Describir el perfil de información pasiva prestada por el Centro de Información de Medicamentos (CIM) de la Facultad de Farmacia de la Universidad Federal de Bahía. Metodología: Estudio prospectivo descriptivo realizado desde marzo de 1997 a diciembre de 2003 de las solicitudes de información (SI) hechas al CIM, utilizando una planilla de Microsoft Excel®, representadas en frecuencias. Resultados: De las 1.267 SI recibidas en el periodo de estudio, el 37 por ciento implicaban a pacientes; el 73 por ciento de las SI fueron realizadas por teléfono y se utilizó esta vía en la respuesta en el 66 por ciento; el 68 por ciento de las SI fueron hechas por farmacéuticos. La mayoría de ellas provinieron del entorno hospitalario (39 por ciento), seguidas por las farmacias de la comunidad (23 por ciento). En el total de SI se contabilizaron 1.459 preguntas, en una proporción de 1,2 preguntas/SI, en las cuales el 18 por ciento de las preguntas se referían a indicaciones y uso de medicamentos, el 13 por ciento eran sobre reacciones adversas a medicamentos, el 17 por ciento eran referentes a identificación de productos nacionales, extranjeros, y principios activos, el 8 por ciento sobre posología y el 6 por ciento sobre interacciones medicamentosas. La respuesta se demoró menos de 23 h en el 59 por ciento de las SI (AU)

Use of oral antihypertensive medication preceding blood pressure elevation in hospitalized patients.

OBJECTIVE: To evaluate the frequency of oral antihypertensive medication preceding the increase in blood pressure in patients in a university hospital, the drug of choice, and the maintained use of antihypertensive medication. METHODS: Data from January to June 1997 from the University Hospital Professor Edgard Santos Pharmacy concerning the prescriptions of all inpatients were used. Variables included in the analysis were: antihypertensive medication prescription preceding increase in blood pressure, type of antihypertensive medication, gender, clinical or surgical wards, and the presence of maintained antihypertensive medication. RESULTS: The hospital admitted 2,532 patients, 1,468 in surgical wards and 818 in medical wards. Antihypertensive medication prescription preceding pressure increase was observed in 578 patients (22.8%). Nifedipine was used in 553 (95.7%) and captopril in 25 (4.3%). In 50.7% of patients, prescription of antihypertensive medication was not associated with maintained antihypertensive medication. Prescription of antihypertensive drugs preceding elevation of blood pressure was significantly (p<0.001) more frequent on the surgical floor (27.5%; 405/1468) than on the medical floor (14.3%; 117/818). The frequency of prescription of antihypertensive drugs preceding elevation of blood pressure without maintained antihypertensive drugs and the ratio between the number of prescriptions of nifedipine and captopril were greater in surgical wards. CONCLUSION: The use of antihypertensive medication, preceding elevation of blood pressure (22.8%) observed in admitted patients is not supported by scientific evidence. The high frequency of this practice may be even greater in nonuniversity hospitals.